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SAN JOAQUIN COUNTY E-,1./3 <br /> ' 1868 E. HAZELTON AVENUE GGtD <br /> STOCKTON, CA 95205 <br /> Office: (209)468-3300 Recorder (NOI): (209)468-3300 FAX: (209)468-3330 <br /> - ------------------------------------------------------------------------------- <br /> RESTRICTED MATERIALS PERMIT Permit#: 39-03-3903133 <br /> County HQ District#: C <br /> EXPORT IMPORT ASSOC INC Expiration Date: 12/31/2003 <br /> 17495 S SEIDNER Effective Date <br /> ESCALON, CA 95320- <br /> JIM BRUGHELLI Home: (209)838-7049 <br /> 17495 S SEIDNER Shop: (209)838-7049 <br /> L ESCALON, CA 95320- Fax: <br /> Mobile: ( )541-6897 <br /> Permittee Type Permit Type Possession NOI Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> Private App [ I Seasonal NQ Pose & Use NQ Phone [IQ Fax [X} <br /> Q A Cert [ I Job [ I Poss Only [ ] Box [X] Modem OU <br /> Ag PCO [ I In Person [X] <br /> Non-Ag [X] NOI required 24 hours prior to application <br /> ------------------------------------------------------------------------------- <br /> L Numb Pesticide Pest(s) Form. Method(s) Applicator(s) <br /> ----- --------------- ------------ -------- ---------------- ----------------- <br /> 4840 ALUMINUM PHOSPH RODENTS Fumigant Fumigate PCO Grower <br /> L <br /> L <br /> L <br /> LNon-Ag Use: COMMODITY FUMIGATION <br /> Conditions: P QAL#QL34429 <br /> LI understand that this permit does not relieve me from liability for any damage <br /> to persons or property caused by the use of these pesticides. I waive any <br /> Lclaim of liability for damages against the County Department of Agriculture <br /> based on the issuance of this permit. I further understand that this permit <br /> may be revoked when pesticides are used in conflict with the manufacturer's <br /> labeling or in violation of applicable laws, regulations and specific <br /> ` conditions of this permit. I authorize inspection at all reasonable times and <br /> whenever an emergency exists, .by the Department of Pesticide Regulation or the <br /> County Department of Agriculture of all areas treated or to be treated, storage <br /> facilities for pesticides or emptied containers and equipment used or to be used <br /> b- in the treatment. [Form PR-ENF-125 (Rev. 07/92) Pesticide E rc n Zane <br /> Permit Applicant: —��Y M' �� Si <br /> Title: <br /> � Date: <br /> ` Issuing Officer: Date: <br />